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Hyperlactaemia without acidosis - an investigation using an in vitro model
1Intensive Care Facility, Division of Anaesthesiology and Intensive Care, Royal Brisbane Hospital, Brisbane, Queensland. morgant@health.qld.gov.au
Summary
Base excess and anion gap do not reliably distinguish aerobic from anaerobic lactate production. Normal values may persist even with severe hyperlactaemia, indicating low sensitivity to lactate elevations.
Area of Science:
- Biochemistry
- Physiology
- Medical Diagnostics
Background:
- Hyperlactaemia is a critical clinical indicator.
- Distinguishing aerobic from anaerobic lactate production is diagnostically important.
- Current markers like base excess and anion gap may have limitations.
Purpose of the Study:
- To simulate aerobic hyperlactaemia using an in vitro blood model.
- To evaluate if base excess and anion gap can differentiate aerobic from anaerobic lactate production.
Main Methods:
- Diluting fresh blood with various crystalloid solutions.
- Measuring normocapnic pH, base excess, strong ion difference, and anion gap.
- Utilizing a dilutional blood model to simulate hyperlactaemia.
Main Results:
- Normocapnic pH correlated strongly with diluent and final strong ion difference.
- Base excess, pH, and anion gap correlated with lactate concentrations when lactate-containing crystalloids were used.
- Metabolic acidosis was indicated only at high final lactate concentrations (10-15 mmol/L).
Conclusions:
- Hyperlactaemia from any source decreases strong ion difference and base excess, and increases anion gap.
- Abnormal base excess and anion gap values cannot differentiate aerobic from anaerobic lactate production.
- Normal values may indicate low sensitivity to mild lactate elevations.